3.

Seeking health care – when health needs are beyond its

capability in terms of knowledge, skills and available time.
4. Managing health and non-health crisis – the family has
to learn to deal with
 The Universal Declaration of Human Rights ,Article 16
states that the family is the natural and fundamental unit of 1. Shared sense of being a community based on history
society and is entitled to protection both by society & the state and values
 Family – is the unit of care. It is a group of persons 2. A general feeling of empowerment and control over
usually living together composed of the head and other matters that affect the community as a whole.
persons related to the head either by blood, marriage or 3. Existing structures that allow subgroups within the
adoption. community to participate in decision making in community
 The CHN works with and not for the individual patient, matters.
family, group and community. 4. The ability to cope with change, solve problems, and
 The goal of improving community health is realized manage conflicts within the community through acceptable
through multi-disciplinary effort. means.
5. Open channels of communication and cooperation
1. Procreation – for reproductive function and child-rearing among members of the community.
2. Socialization of the family members – family is 6. Equitable and efficient use of community resources, with
considered the first teacher in societal roles the
3. Status placement – characterized by a hierarchy of its view towards sustaining natural resources.
members into social classes.
4. Economic function – family as the unit of production;
wages and income

1. Nuclear – compose of father, mother and children

2. Dyad – empty nesters
3. Extended – consisting of three generations
4. Blended – results from a union of where one or both
spouses bring a child from previous marriages
5. Compound – where a man has more than 1 spouse –
Muslim;
one man/woman with several spouses
6. Cohabiting – live-in
7. Single Parent – only one parents is supporting the
needs of the members
8. Gay/Lesbian – same sex marriage
9. Foster – substitute family for children whose parents are
unable to care for them.
10. Communal – more than one monogamous couple
sharing re sources

1. Beginning Family – marriage or commitment

2. Families with young children –integration of children
into the family
3. Families with adolescent –development of increasing
autonomy
for adolescents
4. Launching Family – youngest child leaves home
5. Middle Aged Family – remaining marital dyad to
retirement
6. Aging Family – from retirement to death of both spouse

An important responsibility of the community health nurse

is to develop the family’s capability in performing its health
tasks.
1. Providing its members with means for health promotion
and disease prevention - breastfeeding, diet, immunization,
diet.
2. Recognizing interruptions of health or development –
dealing with unacceptable health condition.
 3. Providing nursing care to the sick, disabled, and/or
dependent members of the family.
- is a process utilized to systematize the helping process 4. Maintaining a home environment conducive to health
extended to the clients maintenance and personal development.
- basically it is the use of scientific method of exploring and 5. Maintaining a reciprocal relationship with the community
analyzing data to arrive at logical conclusions and rational and its health institutions- implies effective utilization of
solutions to problems community resources for health care

I. ASSESSMENT 1. Direct observation

- Collection and analysis of factual information relevant to 2. Interviewing
client’s status, his capacity to solve health problems and 3. Other methods- include review existing records and
his environment reports pertinent to the client.
- The following are resources of data in assessment: e.g. clinical records of family members’ immunization

1. Analyses of data taken from this source reflect

deviations in health development of individuals. I. ESTABLISHES A WORKING RELATIONSHIP WITH
2. Nurse needs adequate skills in determining deviations in THE FAMILY
physical and psychosocial aspects of a person’s health. II. CONDUCTS AN INITIAL ASSESSMENT TO
3. Broad knowledge based on the socio-cultural variables DETERMINE THE PRESENCE OF
affecting health, illness and help-seeking behaviours. ANY HEALTH PROBLEM
III. CATEGORIZES HEALTH PROBLEMS
IV. DETERMINE THE NATURE AND EXTENT OF THE
FAMILY’S PERFORMANCE OF THE HEALTH TASKS ON
1. Analyses of data taken from this source reflect the nature EACH OF THE HEALTH PROBLEMS CATEGORIZED IN
and extent of the family’s performance of specific health NO.3
tasks to meet the physical, social and emotional needs of V. DETERMINE PRIORITIES AMONG THE LIST OF
its members. HEALTH PROBLEMS
2. Nurse needs knowledge on group processes, family role VI. RANK THE HEALTH PROBLEMS ACCORDING TO
relationships, and family decision-making and family PRIORITIES
communication patterns. VII. DECIDE ON WHAT PROBLEMS TO TACKLE IN THE
ORDER OR IMMEDIACY/URGENCY, BASED ON
1. Home and the community. PRIORITIES SET
2. Knowledge-based required for an adequate assessment VIII. DEFINES NURSING OBJECTIVES (SMART)
of physical and socio- cultural threats to health and JOINTLY WITH THE FAMILY
development. IX. PLANS APPROACHES, STRATEGIES OF ACTION
CRITERIA AND STANDARDS FOR EVALUATION
X. IMPLEMENTS PLAN OF CARE
- This is where planning and putting plans to actions are XI. EVALUATES THE EFFECTIVITY OF IMPLEMENTED
done ASPECTS OF THE PLAN
- The phase where the nurse formulates the following: XII. REDEFINES NURSING PROBLES AND
a. Goals REFORMULATES OBJECTIVES ACCORING TO
b. Objectives EVALUATION FINDINGS
c. Nursing Actions

- Done to demonstrate whether or not the intended results

did occur a. Initiates contact
b. Communicates interest in the family’s welfare
c. Express/show willingness to help with expressed needs
1. FIRST LEVEL ASSESSMENT- content of the initial data d. Maintains a two-way communication with the family
base.
2. SECOND LEVEL ASSESSMENT – reflects the extent
to which the family can perform the health task on each
health threat, health deficit and stress point. TOOL: INITIAL DATA BASE (first level assessment data)
INITIAL DATA BASE FOR FAMILY NURSING PRACTICE
A. FAMILY STRUCTURE AND CHARACTERISTICS
1. Recognizing interruptions of health development- refers 1. Members of the household and relationship to the head
to the family’s ability to recognize the presence of a health of the family
problem. 2. Demographic data- age, sex, civil status, position in the
2. Making decisions about taking appropriate health family
actions. 3. Place of residence of each member- whether living with
family or elsewhere
 4. Type of family structure- matriarchal, patriarchal, c. Fire hazards
nuclear, extended d. Fall hazards
5. Dominant family members in terms of decision-making 5. Nutritional
in matters of health care a. Inadequate food intake both in quantity and quality
6. General family relationship b. Excessive intake of certain nutrients
B. SOCIO-ECONOMIC AND CULTURAL FACTORS c. Faulty eating habits
1. Income and expenses 6. Stress-provoking factors
a. Occupation, place of work and income of each a. Strained marital relationships
working member b. Strained parent-sibling relationship
b. Adequacy to meet basic necessities c. Interpersonal conflicts between family members
c. Who makes decisions about the money and how it 7. Poor environmental sanitation
is spent a. Inadequate living space
2. Educational attainment of each member b. Inadequate personal belonging/utensils
3. Ethnic background and religious affiliation c. Lack of food storage facilities
4. Significant others d. Polluted water supply
5. Relationship of the family to a larger community e. Presence of breeding places of insects and
C. ENVIRONMENTAL FACTORS rodents
1. Housing f. Improper garbage/refuse disposal
a. Adequacy of living space g. Unsanitary waste disposal
b. Sleeping arrangement h. Improper drainage system
c. Adequacy of furniture i. Poor lighting and ventilation
d. Presence of insects and rodents j. Noise pollution
e. Presence of accident hazards k. Air pollution
f. Food Storage and cooking facilities 8. Unsanitary food handling and preparation
g. Water supply- source, ownership, potability 9. Personal habits/practices
h. Toilet facility- type, sanitary condition a. Frequent drinking alcohol
i. Garbage disposal- type, sanitary condition b. Excessive smoking
j. Drainage system- type, sanitary condition c. Walking barefooted
2. Kind of neighbourhood d. Eating raw meat/fish
3. Social and health facilities available e. Poor personal hygiene
4. Communication and transportation facilities available f. Self-medication
D. HEALTH ASSESSMENT OF EACH MEMBER g. Use of dangerous drugs/narcotics
1. Medical and Nursing history including past significant h. Sexual promiscuity
illnesses, beliefs and practices i. Engaging in dangerous sports
2. Nutritional assessment 10. Inherent personal characteristics- e.g. short temper
a. Anthropometric- height weight, mid-arm 11. Health history which may precipitate/induce the
circumference occurrence of a health deficit-
b. Dietary history indicating quality and quantity of food e.g. previous history of difficult labor
intake per day 12. Inappropriate role assumption
c. Eating/feeding habits or practices 13. Lack of immunization/inadequate immunization status
3. Current health status indicating presence of illness state specially of children
E. VALUE PLACED ON PREVENTION OF DISEASE 14. Family disunity
1. Immunization status of children 15. Others, specify
2. Use of other preventive services
B. HEALTH DEFICIT
-instances of failure in health maintenance
1. Illness states regardless whether it is diagnosed or
TOOL: TYPOLOGY OF NURSING PROBLEMS IN underdiagnosed by medical practitioner.
FAMILY NURSING 2. Failure to thrive/develop according to normal rate
PRACTICE: FIRST LEVEL ASSESSMENT 3. Disability arising from illness, whethetransient/temporary
A. HEALTH THREAT -e.g. paralysis, leg amputation, blindness, and lameness
-conditions that are conducive to disease, accident or failure C. FORSEEABLE CRISIS OR STRESS POINTS
to realize one’s health potential - Anticipated periods of unusual demand on the individual or
1. Health history of specific condition/disease- e.g. family family in terms of adjustment/family resources
history of diabetes 1. Marriage
2. Threat of cross-infection from communicable disease 2. Pregnancy, labor
case 3. Parenthood
3. Family size beyond what family resources can 4. Additional member- e.g. new born, lodger
adequately provide 5. Abortion
4. Accidental hazards 6. Entrance at school
a. Broken stairs 7. Adolescence
b. Pointed or sharp objects, poisons, and medicines 8. Loss of job
improperly kept 9. Death of a member
 10. Resettlement in a new community H. Member’s preoccupation with own concerns/interests
11. Illegitimacy I. Others, specify
12. Others, specify IV. INABILITY TO PROVIDE A HOME ENVIRONMENT
WHICH IS
CONDUCIVE TO HEALTH MAINTENANCE AND
PERSONAL DEVELOPMENT DUE TO:
A. Inadequate family resources
TOOL: TYPOLOGY OF NURSING PROBLEMS IN
B. Failure to see benefits (specially long-term ones) of
FAMILY NURSING
investment in home environment improvement
PRACTICE: SECOND LEVEL ASSESSMENT
C. Ignorance of importance of hygiene and sanitation
I. INABILITY TO RECOOGNIZE THE PRESENCE OF A
D. Ignorance of preventive measures
PROBLEM DUE TO:
E. Lack of skill in carrying out measures to improve home
A. Ignorance of facts
environment
B. Fear of consequences of diagnosis of problem
F. Ineffective communication patterns
1. Social stigma loss of respect of peer/significant
G. Attitude/philosophy in life
others
H. Others, specify
2. Economic cost
V. FAILURE TO UTILIZE COMMUNITY RESOURCES FOR
3. Physical/psychological
HEALTH CARE DUE TO:
C. Attitude/Philosophy
A. Ignorance or lack of awareness of community resources
D. Others, specify
for health care
II. INABILITY TO MAKE DECISIONS WITH RESPECT TO
B. Failure to perceive the benefits of health care or services
TAKING APPROPRIATE HEALTH ACTION DUE TO:
C. Lack of trust or confidence in the agency or personnel
A. Failure to comprehend the nature, magnitude/scope of
D. Previous unpleasant experience with health worker
the problem
E. Fear of consequences of action
B. Low salience of the problem
F. Unavailability of required care/service
C. Feeling of confusion and/or resignation brought about
G. Inaccessibility of required care/service
by failure to break down problems into manageable units
H. Lack or inadequate family resources
of attack
I. Feeling of alienation of lack of support from the
D. Lack of knowledge/insight as to alternative courses of
community
action open to them
J. Attitude/philosophy in life
E. Inability to decide which action to take from among a list
K. Others, specify
of alternatives
F. Conflicting opinions among family members or
significant others regarding action to take
G. Ignorance of community resource for care
TOOL: SCALE FOR RANKING FAMILY HEALTH
H. Fear of consequences of action
PROBLEMS ACCORDING TO PRIORITIES
I. Negative attitude towards the health problem- by
A. NATURE OF THE PROBLEM
negative attitude is meant one that interfere as with rational
- categorizes the problem as health threat, health
decision-making
deficit, or stress points
J. Inaccessibility of appropriate resources of care
B. MODIFIABILITY OF THE PROBLEM
K. Lack of trust/confidence in the health personnel or
- Refers to the probability of success in minimizing,
agency
alleviating or totally eradicating the
L. Misconceptions or erroneous information about
problem through nursing intervention
proposed courses of action
1. Current knowledge, technology, and interventions to
M. Others, specify
manage the problem
III. INABILITY TO PROVIDE ADEQUATE NURSING CARE
2. Resources of the family- physical, financial and
TO THE SICK, DISABLED, DEPENDENT OR
manpower
VULNERABLE OR AT RISK MEMENER OF THE FAMILY
3. Resources of the nurse- knowledge, skills and time
DUE TO:
4. Resources of the community- facilities and community
A. Ignorance of facts about the disease or health condition
organization or support
(nature, severity, complications, prognosis, and
C. PREVENTIVE POTENTIAL OF THE PROBLEM
management); child development and child care
- Refers to the nature and magnitude of future
B. Ignorance of the nature and extent of nursing care
problems that can be minimized or totally prevented if
needed
intervention is done on the problem under
C. Lack of the necessary facilities ( equipment and
consideration
supplies) for care
1. Gravity or severity of the problem
D. Lack knowledge and skill in carrying out the necessary
2. Duration of the problem
treatment/procedure/care
3. Current management
E. Inadequate family resources of care
4. Exposure of any high risk group
F. Negative attitude towards the sick, disabled, dependent
D.SALIENCE OR FAMILY’S PERCEPTION/
vulnerable
EVALUATION OF EACH PROBLE IN TERMS OF
G. Attitude/philosophy in life
SERIOUSNESS AND URGENCY BASED ON
PRIORITIES SET

1. Health problem
2. Family nursing problems
3. Goals of care
4. Objectives of care
5. Intervention measures
6. Method of Nurse-Family Contact
7. Resources Required
8. Evaluation

1. HEALTH PROBLEM
- A situation or condition which interferes with the
promotion and/or maintenance of health and recovery from
illnesses and injury
2. FAMILY NURSING PROBLEMS
- A health problem becomes a nursing problem when it can
be modified through nursing interventions
3. GOALS OF CARE
- General statements of purpose
- The end towards which all efforts are directed
- Broadly state
- Not measurable
4. OBJECTIVES OF CARE
- are more specific statements of the desired results of
outcome after giving the nursing intervention
5. INTERVENTION MEASURES
- Refers to the expected behaviors that the nurse will
perform with the patient must be taken for a source and
must have a footnote at the end of each intervention
 Health threats
condition which predispose to disease, accident, poor or
retarded growth and development and personality
Family health nursing process is a systematic approach to disorders
help family to develop and strengthen its capacity to meet its The possible health threats are
health needs and solve health problems. -large family size
STEPS -lack of education
-assessment phase -immature parents
-planning phase -broken family
-implementation phase -poor environmental condition
-evaluation phase -poor sanitation
-environmental pollution
I. Assessment phase (family identification) -incomplete immunization
The standards of determining family health status can be -unbalanced diet
-optimum health of individual member Foreseeable crisis situations-anticipated periods of
-family life style unusual demands on the individual or the family in terms of
-family environment adjustment . They are
-family structure, characteristics compare families -marriage
health with these standards -pregnancy
Steps of assessment phase -new born
-plan for data collection -developmental stages
-data collection methods and techniques -new job
-analysis of data -death
-family profile and diagnosis -change in residence
1) plan for data collection
It includes data regarding Health threats and foreseeable crisis situation are potential
-family structure and characteristics problems and health deficits are actual problems
-life style, culture and socio economic factors
-health and medical history and health behavior 4) Family profile and diagnosis
-environmental factors  Family profile implies brief description of family
Primary source of data collection- obtained directly from structure and characteristics, family life cycle and
the client (family members) culture, socio economic conditions environmental
Secondary source of data collection- obtained through factors health and medical history etc.
friends, neighbours, colleagues, family records, family team  Family health diagnosis is the written statement of
members, investigation reports, reference books etc. family health problems which are assessed from
2) Data collection methods and techniques analysis of data collected
-Observation II. PLANNING PHASE (FAMILY HEALTH AND NURSING
-questioning CARE PLAN FORMULATION)
-conversation and discussion -it is based on the diagnosis
-listening steps of planning phase
-review of family health records -analysis of diagnosed health problems and assessment of
-examination families ability to resolve problems (second assessment)
-investigation -establish priorities
-interview -setting goals and objectives
Guidelines for data collection -formulating family health and nursing care plan
-be systematic 1) Analysis of diagnosed health problems and
-do not force to get information assessment of families ability to resolve problems
-explain the reason for data collection (second assessment)
-ensure confidentiality Families ability to resolve health problems can be
-be polite assessed on the basis of
-don't let the family feel small and embarrassed -ability to recognize the presence of health problems
-make them comfortable -ability to make decisions for taking appropriate health
-sympathizes and listen attentively and meaningfully action
-record the data -ability to provide desired care to the sick disabled
3) analysis of data -ability to maintain environment conducive to health
It should be categorized as health deficit, health threats promotion maintenance and personnel development
and foreseeable crisis situations - Ability to utilize community for health care
Health deficits-failure in health maintenance and 2) Establish priorities
development.. -means rank ordering of the health problems Criteria for
-diagnosed illness setting priorities
-deviation in growth and development a)Type of problem- health deficit, health threats and
-personality disorders foreseeable crisis situations
 b)Severity of the consequence of the problem- nature IV. EVALUATION PHASE (FAMILY HEALTH AND
and magnitude of the problem NURSING CARE EVALUATION)
c)Modifiability of the problem- possibility of resolving the QUANTITATIVE AND QUALITATIVE
problem through nursing interventions within available QUANTITATIVE EVALUATION
resources It determine the extent of services rendered to the family .
d)salience-families perception about the seriousness of It accounts the number of visits , clinic visits, no. of
the problem immunization completed, reduction in mortality and
e)Preventive potential-whether the problem can be morbidity
prevented, eradicated or controlled. QUALITATIVE EVALUATION
3) setting goals and objectives -has 3 dimensions
Client focused goal-provide need based care to Structure evaluation-it measure the adequacy of resources
malnourished children in terms of manpower, material, time etc.
Nurse focused goal- after the nursing intervention the Process evaluation-it measure the adequacy of nurses
mother will be able to provide need based care to actions and activities implementing the nursing process
malnourished children Outcome evaluation- it measure the end result of the care
Factors influence the goal formulation given to the client
-interpersonal relationship Tools of data collection
-families perception of the problem -direct observation
-families felt need -questing
-families perception about seriousness of the problem -record review
-families ability to face the reality

Selecting appropriate nursing intervention

supplemental-direct nursing care services by the CHN to the Herbal Medicines (SANTALUBBY):
sick *Sambong (diuretic)
developmental-CHN prepare some family members to give *Akapulko (anti-fungal)
similar care in her absence
*Niyug-Niyogan (anti-helmintic)
facilitative-CHN improve families physical facilities either by
*Tsaang Gubat (stomachache)
modifying the exiting facilities or by developing new facilities
*Ampalaya (DM)
CHN has to consider the available resource while planning *Lagundi (cough)
intervention. They are *Ulasimang bato (lower uric acid)
Family resourses-physical intellectual capabilities, *Bawang (HPN)
physical facilities, finance etc. *Bayabas (washing wounds)
Community resourses-health programmes, community *Yerba Buena (pain)
organization etc.
Nurses resourses-her competency, time, support etc.

4) Family health nursing care plan

-data analyzed- health problem prioritized- goals and
objectives established- nursing interventions decided.... All
these components put together for the schematic
representation of the care plan
It should be,
-realistic
-consistent with the goals
-agreeable to the family
-need active involvement of the family members
-in written form
III. ACTION PHASE (FAMILY HEALTH AND NURSING
CARE PLAN IMPLEMENTATION STEPS
-review of plan and mobilization of resources
-implementation and documentation CHN required to
-give adequate informations
-help family to understand the situation
-relate families exiting socio economic condition to health
problem
-motivate family to implement actions
-utilize the equipments and supplies
-help family to utilize the community resources